A place for a tired old woman to try to figure things out so that the world makes a bit of sense.

Saturday, December 05, 2009

Stupid Is As Stupid Does

I don't know which surprises me more: the fact that both the Senate and the House bills on health care reform contain a "cost-saving" provision that will result in much higher costs to Medicare in the long run or the fact that the NY Times would point that out on the front page of today's edition. The provision in question would cut Medicare spending on home health care.

Now, California Governor Arnold Schwarzenegger just did the same thing to Medi-Cal (the state's Medicaid program), but he at least was honest enough to admit that the result would be a mass migration of beneficiaries from their own homes to nursing homes at a much higher cost to the program. His position was that the state could deal with that problem as it arose. Of course, Arnold is a lame-duck (term limits), so he doesn't have to worry about it. The 111th Congress isn't being quite so candid, as the NY Times article points out.

As they are across the nation, Medicare patients and nurses in this town in northern Maine are anxiously following the Congressional debate because its outcome could affect Medicare’s popular home health benefit in a big way. The legislation would reduce Medicare spending on home health services, a lifeline for homebound Medicare beneficiaries, which keeps them out of hospitals and nursing homes.

Under the bills, more than 30 million Americans would gain health coverage. The cost would be offset by new taxes and fees and by cutbacks in Medicare payments to health care providers. [Emphasis added]

The theory is that home health care providers would become more efficient to offset the loss in revenue. The problem with the theory is that home health care is not like an assembly line geared to mass production. A home health care worker can only deal with one patient at a time, and visits frequently take much longer than the time it takes to check a healing wound or listen to a heartbeat. What Congress is contemplating, while not as dramatic as the "death panels" the GOP fringes keep talking about, is taking money for services provided to elders and transferring it to underwrite the uninsured.

Home care shows, in microcosm, a conundrum at the heart of the health care debate. Lawmakers have decided that most of the money to cover the uninsured should come from the health care system itself. This raises the question: Can health care providers reduce costs without slashing services?

Under the legislation, home care would absorb a disproportionate share of the cuts. It currently accounts for 3.7 percent of the Medicare budget, but would absorb 10.2 percent of the savings squeezed from Medicare by the House bill and 9.4 percent of savings in the Senate bill, the Congressional Budget Office says. [Emphasis added]

More importantly, however, the "savings" will not be savings at all. With fewer to zero home health care visits, elders dependent on that health care to remain in their own homes or with their families will have to move into hospitals which can provide the needed care. The whole point of home health care is to save Medicare funds by allowing people to remain at home. Really, it's not that difficult a concept, unless, of course, one is a member of congress which has the best health care program around.

5 Comments:

We do not need these people crowding our overloaded emergency departments and hospital wards. We have plenty of seriously acute patients already. And nursing homes are also overcrowded and understaffed.

Funds for home care should be increased. At least anyone with half a functioning brain would say so.

Coming from a rural state, where home health care sometimes equals all the healthcare or contact an elder has,reducing home health is not even penny wise. It's just plain foolish. Prevention is always cheaper, even if it's less dramatic. Yet we won't fund it, preferring instead to wait until health issues send a senior into the ER or a nursing home. In some cases, the social aspect of congregate care is a good thing, but as long as seniors can maintain their independence with scheduled assistance, it's far less expensive, both in money and emotion, to help them stay at home. Deborah McLean, Maine Senior Guide (www.maineseniorguide.com)

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